MC-18-2163 (2)y` Miami Shores VillageyeoR£s
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
FCORtDA
Permit NO. MC-8-18-2163
Permit Type: Mechanical - ResidentialPentWorkClassification: Addition/Alteration
Perit Status: APPROVED
Issue Date: 8/17/2018 1 Expiration: 02/13/2019
Project Address Parcel Number Applicant
1199 NE 102 Street 1132050190010
Miami Shores, FL 33138-2649 Block: Lot:
ANELIA SHAHEED
Owner Information Address Phone Cell
NIHAR PATEL 1199 NE 102 Street (248)561-1523
MIAMI SHORES FL 33138-2649
1199 NE 102 Street
MIAMI SHORES FL 33138-2649
Contractor(s) Phone Cell Phone
AIR SYSTEMS CONTRACTOR INC (305)224-3972
Tons:
Valuation: $ 14,000.00
Total Sq Feet: 0
iional Info: RENOVATION AND HOME IMPROVEMENTS TO
sification: Residential
oved: In Review
ments: Date Approved:: In Review
Denied: Type of Work: RENOVATION AND HOME IMPROVE
ning: 1
Fees Due Amount
CCF 8.40
DBPR Fee 7.35
DCA Fee 4.90
Education Surcharge 2.80
Permit Fee 490.00
Scanning Fee 3.00
Technology Fee 11.20
Total: 527.65
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-8-18-68544
08/14/2018 Credit Card $ 50.00 $ 477.65
08/17/2018 Credit Card $ 477.65 $ 0.00
tivanaoie mspecuons:
Inspection Type:
Final
Rough Duct
Review Mechanical
Underground
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I rtify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
constructionjaad-Z6-nW. Futhermore, I authorize the above -named contractor to do the work stated.
August 17, 2018
A Afior ed Signature: Owner / Applicant / Contractor / Agent
Buil ing Department Copy
August 17, 2018
Miami Shores Village l
Building Department WAUGI1810050N.E.2nd Avenue, Miami Shores, Florida 33138 B
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 200
BUILDING Master Permit No. 9(, ` S-ri—Io1 S
PERMIT APPLICATION Sub Permit No. RC 2163
BUILDING ELECTRIC ROOFING REVISION EXTENSION RENEWAL
PLUMBING 0 MECHANICAL PUBLIC WORKS CHANGE OF CANCELLATION SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1199 NE 102ND STREET
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#:11-3205-019-0010 Is the Building Historically Designated: Yes __ NO X
Occupancy Type: Load: Construction Type: Flood Zone: X BFE: NA FFE:
OWNER: Name (Fee Simple Titleholder): NIHAR PATEL/ANELIA SHAHEED Phone#:954-261-5218
Address:1199 NE 102ND STREET
City: MIAMI SHORE State: FL Zip: 33138
Tenant/Lessee Name: NA Phone#: NA
Email: AILENALOVE@HOTMAIL.COM
CONTRACTOR: Company Name: Li / Srili7 S '%' 'Y C 7' Phone#: ' 2e? d
Address: -i -,"Sad -Ve,j4 -^1A
r '-
City: State: C!-1<<- // ,,.." Zip:
p / k- ,-'4-4 cl QQ/1 ,1 'sJ Phone#: - 7 Z Z 4 3G!_-i z. Qualifier Name: ,.,.°
State Certification or Registration #. / 3 % 7 / Certificate of Competency #:
DESIGNER: Architect/Engineer: STEPHEN BRASGALLA PA Phone#: 954-614-3801
Address:6991 W BROWARD BLVD SUITE 100 City: PLANTATION state: FL Zip: 33317
Value of Work for this Permit: $ / Lyi047`1 '. Square/Linear Footage of Work:
Type of Work: Addition Alteration New Repair/Replace Demolition
Description of Work: RENOVATION AND HOME IMPROVEMENTS TO EXISTING HOME, KITCHEN
BATHROOMS AND GENERAL OVERALL.
Specify color of color thru tile:
I
Submittal Fee $ v a 1 Ck Permit Fee $
q /
Radon Fee $ ly DBPR $ Notary $ ScanningFee $ Technology
Fee Structural
Reviews $ Training/
Education Fee $ v
CCF $
CO/CC $ Double
Fee $ Bond $
TOTAL
FEE NOW DUE $ Revised02/
24/2014)
Bonding Company's Name (if applicable) NA
Bonding Company's Address NA
City NA State NA
Mortgage Lender's Name (if applicable) AIG HOME LOAN
Mortgage Lender's Address PO BOX 77404
city EWING State NEW JERSEY
Zip NA
Zip 08628
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Signature
OWNER or AGENT el
The foregoing instrument was acknowledged before me this
q1\ day of M OJJ 20 (O , by
ochle'l 141 -S hAeewl. who is personally known to
me or who has produced
identification and who did take an oath.
NOTARY
Sign:_
Print:
Seal: = , "'g :, Notary Public -9tateofFlorida
Commission # GG 097441
N• , Mv4omm. Expires Aug 20, 2021
Bonded throuahNational Notary Assn Signature '
5 e CONTRACTOR
The
foregoing instrument was acknowledged before me this day
of 20 by who
is personally known to as
me or who has produced identification
and who did take an oath. NOTARY
PUBLIC: Print:
MY
COMM IM 8 GG 211203 Seal: ; ,
EXPIRES' My24,2M Ai"O; as
APPROVED
BY Plans Examiner Zoning Structural
Review Clerk Revised02/
24/2014)
Date: 3
State of
County of
Before me this day personally appeared 1&WVt1,. 44Z,4)
who, being duly sworn, deposes and say:
That he or she will be only person working on the project
locate at:
r
Con ra or signature
Swo n to (or affirmed) and scribe before e 's - day
of 2018 by
k, vd .. Personally knout _.• JUANL.CABALLERO
MY COMMISSION # GG 211203Orproducedidenti7ation .F EXPIRES: July24,2022EoxF` Bonded Thru Notary Public UnderwritersTypeofidentificationproduced='"'
Print type or stamp name of
notary
Notice to Owner — Workers' Com
Miami shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
nsation Insurance Exemption
Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05
allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to
obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure:
An employer in the construction industry who employs one or more part-time or full-time
employees, including the owner, must obtain workers' compensation coverage. Corporate officers
or members of a limited liability company (LLC) in the construction industry may elect to be
exempt if:
1. The officer owns at least 10 percent of the stock of the corporation, or in the case of
an LLC, a statement attesting to the minimum 10 percent ownership;
2. The officer is listed as an officer of the corporation in the records of the Florida
Department of State, Division of Corporations; and
3. The corporation is registered and listed as active with the Florida Department of
State, Division of Corporations.
No more than three corporate officers per corporation or limited liability company members are
allowed to be exempt. Construction exemptions are valid for a period of two years or until a
voluntary revocation is filed or the exemption is revoked by the Division.
Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami -Dade
The foregoing was acknowledge before me this i 3 day of Agaves -Z , 20 .
1
Byj Q, j ( hahe (c who is personally known to me or has produced
as identification_.
OFUM FERN
Ndwy pwft • sun of fww
COnWMooioa 0 FF 9n?9?
IV Com. Exekaa Jan 22 "A (
STATE OF FLORIDA DEPARTMENT
db&'*-%r ROF BUSINESS
p EGULATION
AND PROFESSIONAL
CAC1817321 ISSUED:06/29/2018
CLASS B AIR CONDITIONING CONTRACTOR
SANTANA, ALEXANDER
AIR SYSTEMS CONTRACTOR INC
0-SjghatuFe
LICENSED UNDER CHAPTER 489, FLORIDA STATUTES
EXPIRATION DATE: AUGUST 31,'2020